title: Physical performance and frailty in chronic kidney disease.
abstract: BACKGROUND
  Poor physical performance and frailty are associated with elevated risks of death and disability. Chronic kidney disease (CKD) is also strongly associated with these outcomes. The risks of poor physical performance and frailty among CKD patients, however, are not well established.
  
  
  METHODS
  We measured the Short Physical Performance Battery (SPPB; a summary test of gait speed, chair raises and balance; range 0-12) and the five elements of frailty among 1,111 Chronic Renal Insufficiency Cohort participants. Adjusting for demographics and multiple comorbidities, we fit a linear regression model for the outcome of SPPB score and an ordinal logistic regression model for frailty status.
  
  
  RESULTS
  Median (interquartile range, IQR) age was 65 (57-71) years, median estimated glomerular filtration rate (eGFR) for non-dialysis patients was 49 (36-62) ml/min/1.73 m(2), and median SPPB score was 9 (7-10). Seven percent of participants were frail and 43% were pre-frail. Compared with the SPPB score for eGFR >60 ml/min/1.73 m(2), the SPPB was 0.51 points lower for eGFR 30-59; 0.61 points lower for eGFR 15-29, and 1.75 points lower for eGFR <15 (p < 0.01 for all comparisons). eGFR 30-59 (odds ratio, OR 1.45; p = 0.024), eGFR 15-29 (OR 2.02; p = 0.002) and eGFR <15 (OR 4.83; p < 0.001) were associated with worse frailty status compared with eGFR >60 ml/min/1.73 m(2).
  
  
  CONCLUSIONS
  CKD severity was associated with poor physical performance and frailty in a graded fashion. Future trials should determine if outcomes for CKD patients with frailty and poor physical performance are improved by targeted interventions.
authors.affiliation: Renal Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pa., USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Anne R
authors.initials: AR
authors.lastname: Cappola
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Crystal A
authors.initials: CA
authors.lastname: Gadegbeku
authors.forename: Cheryl
authors.initials: C
authors.lastname: Anderson
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Baker
authors.forename: Dean
authors.initials: D
authors.lastname: Carlow
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sulik
authors.forename: Joan C
authors.initials: JC
authors.lastname: Lo
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.forename: Laura
authors.initials: L
authors.lastname: Mariani
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005221:Fatigue; D005260:Female; D005684:Gait / Q000502:physiology*; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D015999:Multivariate Analysis; D018908:Muscle Weakness; D016017:Odds Ratio; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012307:Risk Factors; D015431:Weight Loss